The place of closed mitral valvotomy in the modern cardiac surgery era

The study aim was to investigate the long-term efficacy of closed mitral valvotomy (CMV).

Data obtained over a 36-year period from 1,134 patients who underwent CMV were analyzed. The analysis was carried out retrospectively from hospital records, with follow up examinations being conducted mainly at the outpatient clinic.

In-hospital mortality (< or = 30 days after surgery) was 0.4% (n = 5, all closed procedures). Cardiac failure was the main cause of early death, and postoperative peripheral embolism occurred in five cases (0.5%). Freedom from thromboembolism was 99.0 +/- 0.5% at 36 years. Operative results were satisfactory in most patients, and severe mitral incompetence was seen only in three cases. Post-valvotomy mitral regurgitation occurred in 88 patients (7.7%) during the first year after CMV. Reoperation was performed in 500 patients (44.1%). The mean interval between CMV and reoperation was 141.1 +/- 80.8 months (range: 1-436 months). Fourteen patients were reoperated on for mitral regurgitation, 485 for mitral restenosis, and five for mixed mitral valve disease (stenosis and regurgitation). Freedom from reoperation after CMV was 81.4 +/- 1.3% at 10 years, 16.4 +/- 2.1% at 20 years, 3.1 +/- 1.2% at 20 years, and 0% at 36 years. Cox regression analysis indicated that impaired functional capacity, reduced mitral valve area, gradual increase in left atrial diameter and postoperative mitral insufficiency increased the reoperation rate after CMV.

When compared with percutaneous balloon or surgical open valvotomy, CMV represents a satisfactory technique in terms of simplicity, high efficacy and lower cost.